Financial Impact of Surgical Site Infections on Hospitals

Shepard, John; Ward, William J.; Milstone, Aaron M.; Carlson, Taylor N.; Frederick, John T.; Hadhazy, Eric; Perl, Trish M.

doi:10.1001/jamasurg.2013.2246

Cited by 211 publications

(143 citation statements)

References 33 publications

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“…1 Reported rates vary according to surgical procedure, spanning <1% for clean procedures 2 to 30% for some colorectal procedures. [3][4][5][6] Standardized surveillance has long been recognized as a minimum and necessary requirement for effectual prevention strategies, [7][8][9] and diminishing SSI rates have been noted following the implementation of surveillance programs.…”

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confidence: 99%

“…13,14 The objectives of this study were (1) to examine rates of SSIs according to operative procedure groups and (2) to analyze trends over time for SSI rates, pathogens responsible for SSIs, and antimicrobial susceptibility of pathogens responsible for SSIs in Victorian hospitals for the period October 1, 2002, to June 30, 2013. data collected between October 1, 2002, and June 30, 2013, were analyzed.…”

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confidence: 99%

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Diminishing Surgical Site Infections in Australia: Time Trends in Infection Rates, Pathogens and Antimicrobial Resistance Using a Comprehensive Victorian Surveillance Program, 2002–2013

Worth

Bull

Spelman

et al. 2015

Infect. Control Hosp. Epidemiol.

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OBJECTIVETo evaluate time trends in surgical site infection (SSI) rates and SSI pathogens in Australia.DESIGNProspective multicenter observational cohort study.SETTINGA group of 81 Australian healthcare facilities participating in the Victorian Healthcare Associated Infection Surveillance System (VICNISS).PATIENTSAll patients underwent surgeries performed between October 1, 2002, and June 30, 2013. National Healthcare Safety Network SSI surveillance methods were employed by the infection prevention staff at the participating hospitals.INTERVENTIONProcedure-specific risk-adjusted SSI rates were calculated. Pathogen-specific and antimicrobial-resistant (AMR) infections were modeled using multilevel mixed-effects Poisson regression.RESULTSA total of 183,625 procedures were monitored, and 5,123 SSIs were reported. Each year of observation was associated with 11% risk reduction for superficial SSI (risk ratio [RR], 0.89; 95% confidence interval [CI], 0.88–0.90), 9% risk reduction for deep SSI (RR, 0.91; 95% CI, 0.90–0.93), and 5% risk reduction for organ/space SSI (RR, 0.95; 95% CI, 0.93–0.97). Overall, 3,318 microbiologically confirmed SSIs were reported. Of these SSIs, 1,174 (35.4%) were associated with orthopedic surgery, 827 (24.9%) with coronary artery bypass surgery, 490 (14.8%) with Caesarean sections, and 414 (12.5%) with colorectal procedures. Staphylococcus aureus was the most frequently identified pathogen, and a statistically significant increase in infections due to ceftriaxone-resistant Escherichia coli was observed (RR, 1.37; 95% CI, 1.10–1.70).CONCLUSIONSStandardized SSI surveillance methods have been implemented in Victoria, Australia. Over an 11-year period, diminishing rates of SSIs have been observed, although AMR infections increased significantly. Our findings facilitate the refinement of recommended surgical antibiotic prophylaxis regimens and highlight the need for a more expansive national surveillance strategy to identify changes in epidemiology.Infect Control Hosp Epidemiol 2015;00(0): 1–8

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confidence: 99%

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confidence: 99%

Diminishing Surgical Site Infections in Australia: Time Trends in Infection Rates, Pathogens and Antimicrobial Resistance Using a Comprehensive Victorian Surveillance Program, 2002–2013

Worth

Bull

Spelman

et al. 2015

Infect. Control Hosp. Epidemiol.

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“…In highrisk groups, such as those who are morbidly obese, rates may be as high as 30% [5,6]. Postoperative infections significantly increase health care costs due to hospital readmissions, reoperations and home healthcare needs [7,8].…”

Section: Introductionmentioning

confidence: 99%

A model to predict risk of postpartum infection after Caesarean delivery*

Moulton

Jelovsek

Lachiewicz

et al. 2017

The Journal of Maternal-Fetal & Neonatal Medicine

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Purpose: The purpose of this study is to build and validate a statistical model to predict infection after caesarean delivery (CD). Methods: Patient and surgical variables within 30 d of CD were collected on 2419 women. Postpartum infection included surgical site infection, urinary tract infection, endomyometritis and pneumonia. The data were split into model development and internal validation (1 January-31 August; N ¼ 1641) and temporal validation subsets (1 September-31 December; N ¼ 778). Logistic regression models were fit to the data with concordance index and calibration curves used to assess accuracy. Internal validation was performed with bootstrapping correcting for bias. Results: Postoperative infection occurred in 8% (95% CI 7.3-9.9), with 5% meeting CDC criteria for surgical site infections (SSI) (95% CI 4.1-5.8). Eight variables were predictive for infection: increasing BMI, higher number of prior Caesarean deliveries, emergent Caesarean delivery, Caesarean for failure to progress, skin closure using stainless steel staples, chorioamnionitis, maternal asthma and lower gestational age. The model discriminated between women with and without infection on internal validation (concordance index ¼ 0.71 95% CI 0.67-0.76) and temporal validation (concordance index ¼ 0.70, 95% CI 0.62, 0.78). Conclusions: Our model accurately predicts risk of infection after CD. Identification of patients at risk for postoperative infection allows for individualized patient care and counseling.ARTICLE HISTORY

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“…(1,10) Infected patients have twice the risk for death or admission to the intensive care unit and a five times greater chance of readmission after discharge. (9)(10)(11)(12)(13) From professional experience at a surgical center, was identified the need to evaluate areas in which to act using ten objectives proposed by the WHO program. The relationship of existing risk between surgical procedure and SSI occurrence, which refers to the sixth objective of the program ("Team will use in a systematic manner known methods to reduce risk of surgical site infection") was highlighted and recommendations to be developed by surgical teams and health institutions.…”

Section: Introductionmentioning

confidence: 99%

Validação de checklist cirúrgico para prevenção de infecção de sítio cirúrgico

et al. 2015

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Objective: To design and validate a surgical checklist to improve patient safety and prevent surgical site infection. Methods: This quantitative study was carried out to validate an instrument created and used for surgical safety. Seven experts validated the instrument. For agreement among experts, was used Kendall's concordance coefficient; if their opinions differed significantly, the Cochran's test was adopted. An instrument is validated when concordance among experts is achieved and its clarity is significant. Results: In the first assessment of the instrument, Kendall's concordance coefficients were 0.230 in terms of pertinence and 0.390 for clarity. These results cauded a reformulation in the checklist. After reformulation, an absolute concordance was achieved for pertinence and no significant difference was seen in terms of clarity. After instrument validation, was created an information system to input data collected. Conclusion: The instrument was validated. It can help improve patient safety and prevent surgical site infection. ResumoObjetivo: Construir e validar checklist cirúrgico para segurança do paciente e prevenção de infecção de sítio cirúrgico. Métodos: Pesquisa quantitativa realizada para validar instrumento criado e utilizado em cirurgia segura. O instrumento foi validado por sete peritos. Para concordância entre os juízes utilizou-se o coeficiente de concordância de Kendall e para verificar se a opinião dos juízes diferiu significativamente, o teste de Cochran. O instrumento é validado se houver concordância entre os juízes e a clareza for significante. Resultados: Na primeira avaliação do instrumento, obteve-se Kendall de 0,230 para pertinência e 0,390 para clareza, o que implicou em reformulação do checklist. Após a reformulação, obteve-se concordância absoluta para pertinência e não houve diferença significativa para clareza. Com o instrumento validado, foi criado um sistema informatizado para inserção dos dados coletados. Conclusão: O instrumento criado foi validado e pode auxiliar na segurança do paciente e prevenção de infecção de sítio cirúrgico.

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Financial Impact of Surgical Site Infections on Hospitals

Abstract: The data suggest that hospitals have a financial incentive to reduce SSIs, but hospitals should expect to see an increase in both cost and revenue when SSIs are reduced.

Cited by 211 publications

References 33 publications

Diminishing Surgical Site Infections in Australia: Time Trends in Infection Rates, Pathogens and Antimicrobial Resistance Using a Comprehensive Victorian Surveillance Program, 2002–2013

Diminishing Surgical Site Infections in Australia: Time Trends in Infection Rates, Pathogens and Antimicrobial Resistance Using a Comprehensive Victorian Surveillance Program, 2002–2013

A model to predict risk of postpartum infection after Caesarean delivery*

Validação de checklist cirúrgico para prevenção de infecção de sítio cirúrgico

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